OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

OCR Pre-granted Automation Project

IC 10370 under ICR 201403-0945-001 · OMB 0945-0006.

Documents and Forms
Document Name
Document Type
Other-form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

OCR Pre-granted Automation Project
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 80

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-form 21138 ID_Civil Rights Infomation Request Form for Medicare Certification Form FINAL 03-19-14.docx Yes Yes Fillable Printable

Health Health Care Services

 

2,900 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,900 0 0 0 0 2,900
Annual IC Time Burden (Hours) 23,200 0 0 0 0 23,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
21138 ID_ASSURANCE OF COMPLIANCE FORM 03-19-14 21138 ID_ASSURANCE OF COMPLIANCE FORM 03-19-14.docx 03/26/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.